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UK ranks eighth out of 13 developed countries on drug usage, finds analysis

Caroline White

1 London

The United Kingdom lags behind several other developed countriesin its use of drugs for dementia and cancer, but comes out nearthe top for its use of cardiovascular medicines, says a report.

But no consistent international pattern emerges for all thedisease categories assessed, even for those countries at thetop of the league table, the findings show.

The report, by Professor Mike Richards, national clinical directorfor cancer services, was drawn up in response to perceived concernsthat UK patients were not getting the same level of access tonewer drugs as their peers elsewhere and to the commitment madein the Pharmaceutical Price Regulation Scheme to develop measurablecomparisons of new medicines uptake in Europe.

The analysis reviewed drug use per head of the population forseven disease categories that are costly to treat in 10 Europeancountries of varying size, plus Australia, New Zealand, andthe US.

The unweighted analysis, which spans the period from April 2008to March 2009, ranks the UK eighth overall, behind several ofits European neighbours—including Spain, France, and Denmark.The US tops the league, and New Zealand comes bottom.

The UK earns second place for its use of cardiovascular drugsthrombolytics for heart attack and cholesterol lowering statinsthe latter being prescribed almost three times as much as theinternational average.

But it scrapes in at 13 for drugs to treat hepatitis C and multiplesclerosis and 11 for antipsychotic and dementia drugs. It managesonly 10th place in the rankings for rheumatoid arthritis drugs.

The UK also occupies 10th place for cancer drug usagewhich thereport analyses in more detailrising to fifth place for hormonalcancer treatments, but dropping to 12th for drugs launched inthe past five years.

The report found that the causes of the variations “appear tobe complex.” There seems to be little correlation between drugusage and health spend to account for the differences, it says,but health technology assessments, such as those by the UK’sNational Institute for Health and Clinical Excellence, can havea substantial impact. Operational, cultural, and epidemiologicalfactors are all likely to play a part, it says.

Professor Richards cautioned against jumping to conclusionsabout quality of care. “There is no right or wrong level ofusage,” he said, adding that it was up to clinicians to decideon appropriate levels. “You can’t take the simplisticview,” he warned.

But the government used the report’s findings to backits announcement of a £50m fund, available from October,to enable patients to access cancer drugs more easily, includingthose currently deemed too expensive or used off label.

The intention is to extend the fund to £200m (240m; $313m),pending the outcome of the comprehensive spending review laterthis year.

“Undoubtedly, this will mean some patients will get access toexpensive drugs who wouldn’t otherwise have done so. Butit’s not revolutionary,” she said. “And it won’tgive the green light to every drug available.”

She also wondered whether this was the best use of NHS money,particularly in the current climate. “To hold yourself to accountby outcomes [as this government has done] raises serious questionsabout why you would choose to invest £50m in drugs asyour greatest chance of achieving them,” she said.